Reading of the Week: Effective Therapy for Anxious & Depressed Youth in a Peds Clinic? The New Weersing Study

From the Editor

“Anxiety and depression in youth are widely prevalent, highly impairing, and woefully undertreated.”

So writes San Diego State University’s V. Robin Weersing and her co-authors in a new JAMA Psychiatry paper. In this study, they compare a pediatric clinic-based brief behavioural treatment to referral to outpatient services for depression and anxiety. It’s a novel approach – and one with significant advantages (housing treatment in a primary care setting, to name just one).

So does this work? Spoiler alert: the brief behavioural treatment (BBT) comes out on top.

Anxiety treatment in the peds office: would Norman Rockwell approve?

As an accompanying Editorial notes: “The efficacy of BBT is particularly telling given the low response rate to treatment as usual in the control condition (57% vs 28%), especially for Hispanic populations (76% vs 7%).”

Please note: there will be no Reading next week because of the APA Annual Meeting. (I hope to see you in California.)

DG

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Reading of the Week: Can We Reduce Suicide in the Emergency Department Population? Also, Drugs & Crime

From the Editor

He presents to the Emergency Department a few days after a suicide attempt. What can we do to help keep this man safe today – and moving forward?

Emergency Departments: noisy, busy, and an opportunity for suicide prevention?

It’s a scenario that repeats itself at EDs across the country with regularity. This week, in our first selection, we consider a new JAMA Psychiatry paper that has just been published looking at suicide prevention in the ED population. The authors claim “this study is the largest suicide intervention trial ever conducted in the United States,” and they show that, with an intervention, they can reduce suicides and suicide attempts.

And, in the other selection, we look at a short New York Times essay in which economist Austin Frakt argues that substance programs pay for themselves in crime reduction.

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Reading of the Week: Economics & Mental Health – the New MHCC Paper; Also, Dr. Beck on Marijuana Legalization

From the Editor

Does investing in mental health make economic sense?

We often speak of mental health spending in terms of human terms – that people will have the opportunity to recover. But what about the economics of mental health?

Economics & mental health: worth considering?

This week, we look at a new report from the Mental Health Commission of Canada. In it, the authors consider the impact of mental illness on our society, and then look at options for spending with an eye on economic returns.

In the other selection, we consider marijuana and public health with a blog by Dr. Gail Beck, a psychiatrist affiliated with The Royal. As Ottawa moves towards legalization, she offers a cautionary note: “Most physicians hope that the federal government will approach the legalization of marijuana emphasizing public health concerns as the most important consideration in the drafting of legislation.”

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Reading of the Week: Technology & Mental Health – Depression and Internet-based CBT; Also, Finnish e-Therapy

From the Editor

VR. e-therapies.

New technology is changing the way we think about the delivery of psychiatric services. But new isn’t necessarily better. Can care really be transformed? What does the literature say?computere-therapy: more than clever pictures of computers and stethoscopes?

In a two-part Reading of the Week, we look at technology and psychiatry.

Last week, Virtual Reality.

This week, e-therapies.

This week, we consider a new paper that has just been published. Its looks at self-guided Internet-based CBT showing that for every eight people treated, one benefits (consider this in the context of minimal cost).

And, in the other selection, we look at the Finnish experience with Internet-based CBT.

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Reading of the Week: Technology & Psychiatry – Can Virtual Reality Help with Pain? Or Social Anxiety?

From the Editor

VR. e-therapies.

New technology is changing the way we think about the delivery of psychiatric services. But new isn’t necessarily better. Can care really be transformed? What does the literature say?

U.S. President Barack Obama tries virtual reality glasses as he and German Chancellor Angela Merkel (R) tour Hanover Messe Trade Fair in Hanover, Germany April 25, 2016. REUTERS/Kevin Lamarque

VR: more than just a presidential photo op?

In a two-part Reading of the Week series, we look at technology and psychiatry.

This week, Virtual Reality.

Next week, e-therapies.

This week, we consider a new paper that looks at virtual reality to treat pain in hospitalized patients. The authors find that people utilizing VR have less pain as compared to controls. This finding leads us to another recent paper on VR; in this second study, patients with social anxiety are treated with a VR intervention.

DG

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Reading of the Week: Breaking the Stigma – Dr. Adam B. Hill on his Depression and Addiction

From the Editor

“My name is Adam. I am a human being, a husband, a father, a pediatric palliative care physician, and an associate residency director. I have a history of depression and suicidal ideation and am a recovering alcoholic.”

So begins this week’s selection, which is an essay written with remarkable candor and honesty.

1docDiscussing what we should discuss

In this Reading, Dr. Adam Hill writes in The New England Journal of Medicine about his struggle with mental illness.

It is moving and important.

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Reading of the Week: Schizophrenia & Diabetes: The Gap in Care; Also, Swedish Health Care

From the Editor 

“The pain in my feet. It’s killing me.”

That’s what John told me when I asked him what he needed help with. It’s not quite the answer I thought he’d give – John has schizophrenia and he has significant side effects from his medications. But, like many people with mental illness, he also struggles with physical illness (diabetes and the accompanying neuropathy).

Many of our patients have both physical and mental illnesses. When faced with these twin challenges, how do they fair?

In this week’s first selection, we look at a new paper that considers people with schizophrenia and diabetes. The study authors find a significant gap between the care received by those with and without mental illness.

insulinAn old drug, an old illness, and a big problem for those with mental illness

In our second selection, drawing from a lively blog written by medical student Ali Damji, we look at Swedish health care.

DG
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Reading of the Week: Can a Fake Intervention Help Real Pain? Also, Preventing Depression

From the Editor 

“To a degree which has never been suspected, what powerful influence upon diseases is produced by mere imagination.” British physician John Haygarth wrote those words more than two centuries ago when considering the placebo effect.

Is it possible to successfully treat people with placebo in an open-label trial? That is, if people know they are taking placebo, will they still experience the benefit of placebo?

painCan a fake intervention help real pain?

In this week’s selection, we look at a new study where participants were offered placebo for back pain. Spoiler alert: it worked.

And, in a new feature for the Reading of the Week, we include an invited letter to the editor from Dr. Albert H. C. Wong who writes about the best way of preventing depression.

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Reading of the Week: Are Cats Making Us Sick? The Solmi et al. Paper, and Prescribing Housing in Hawaii

From the Editor

A few years ago, Czech scientist Jaroslav Flegr made a splash by arguing that our feline friends were causing psychosis in people – The Atlantic provocatively titled their article on him: “How Your Cat is Making You Sick.” Flegr’s argument was based in part on several papers (including by prominent researcher E. Fuller Torrey) noting that cat ownership confers an increased risk of psychotic disorders like schizophrenia.

So, are cats safe for household use?

In our first selection, we look at a new Psychological Medicine paper that, with a cohort study, finds no connection between cat ownership and psychotic symptoms.

Good news, tabby: you can stay

How to help the homeless? In our second selection, drawing from The Guardian, we look at a Hawaiian effort to prescribe the housing to the homeless – literally.

Please note that there will be no Readings for the next two weeks. Enjoy the March break.

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Reading of the Week: Do Markets Work for (Mental) Health Services? The Arrow Paper

From the Editor

His New York Times obituary opens: “Kenneth J. Arrow, one of the most brilliant economic minds of the 20th century and, at 51, the youngest economist ever to win a Nobel, died on Tuesday at his home in Palo Alto, Calif. He was 95.”

Kenneth J. Arrow

As a tribute to Kenneth Arrow, this week’s paper is his “Uncertainty and the Welfare Economic of Medical Care.”

This paper was published decades ago. Our selections try to be current. But we’ll make an exception for a good reason: Kenneth Arrow, one of the most significant economists of the 20th Century, died last week; his work on health care and economics remains deeply influential. Indeed, whether we are discussing the Choosing Wisely campaign or debating the expansion of public coverage under Obamacare, we are essentially weighing in on Arrow’s 1963 health economics paper – which makes this paper a natural choice for this week’s Reading.

Arrow didn’t mention mental health in his 1963 paper. But as we seek to better mental health services, his observations on the problems of health-care information are worth considering.

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